Mauriceau Smellie Veit Manoeuvre

The Mauriceau-Smellie-Veit Maneuver: A Comprehensive Guide for Safe Delivery

The Mauriceau-Smellie-Veit (MSV) maneuver is a crucial obstetric technique used to deliver a baby's head and shoulders during difficult vaginal deliveries. This maneuver is employed when the baby's head is impacted in the pelvis and conventional methods of vaginal delivery are unsuccessful. Understanding this technique is vital for both healthcare professionals involved in childbirth and expectant parents seeking comprehensive knowledge about potential delivery scenarios. This article provides a detailed explanation of the MSV maneuver, its indications, steps, potential complications, and frequently asked questions.

Introduction to the Mauriceau-Smellie-Veit Maneuver

The MSV maneuver is a multifaceted procedure named after three influential obstetricians: François Mauriceau, William Smellie, and Gustav Veit. Each contributed significantly to refining and documenting the technique, making it a cornerstone of modern obstetrics. The maneuver aims to facilitate the delivery of a baby's head and shoulders when they are impacted in the birth canal, often in cases of shoulder dystocia, breech presentation, or other difficult deliveries. It’s a delicate procedure requiring precision and a thorough understanding of fetal anatomy and positioning. While rarely needed, mastering this technique is critical in managing obstetric emergencies and ensuring both maternal and fetal well-being.

Indications for the Mauriceau-Smellie-Veit Maneuver

The MSV maneuver is not a routine delivery method; it's reserved for specific situations where other less invasive techniques have failed. Key indications include:

• Shoulder dystocia: This is the most common indication. It occurs when the baby's shoulders become impacted after the head is delivered.
• Breech presentation: When the baby's buttocks or feet present first, the MSV maneuver might be necessary to guide the delivery of the head.
• Meconium aspiration syndrome: Although not a direct indication, the maneuver might be expedited in cases of meconium aspiration to minimize fetal distress.
• Fetal distress: If the baby shows signs of distress during labor, the MSV maneuver may be considered to expedite delivery.
• Failed vacuum or forceps delivery: If other assisted delivery methods have been attempted and failed, the MSV maneuver might be necessary.

It's crucial to remember that the decision to use the MSV maneuver is made based on a careful assessment of the mother's and baby's condition by experienced healthcare professionals.

Steps in Performing the Mauriceau-Smellie-Veit Maneuver

The MSV maneuver involves a series of precise steps, typically performed by an experienced obstetrician or midwife. Variations exist depending on the specific situation and fetal positioning, but the core principles remain consistent:

1. Preparation and Assessment:

• Careful assessment of fetal position and presentation: This is paramount to ensuring the maneuver is performed correctly. Ultrasound may be used to confirm the position.
• Emptying the bladder: A full bladder can obstruct the birth canal and hinder the maneuver's effectiveness.
• Positioning of the mother: The mother is usually positioned supine with her legs elevated in stirrups (lithotomy position).

2. Delivery of the Head:

• Suprapubic pressure: Gentle suprapubic pressure is applied to assist in the delivery of the anterior shoulder. This pressure helps rotate the shoulders.
• Grasping the fetal head: The obstetrician uses a controlled grasp to stabilize the fetal head, often using the thumbs placed on either side of the occiput, near the posterior fontanelle.

3. Flexion and Delivery of the Shoulders:

• Flexion of the head: The obstetrician gently flexes the fetal head downward towards the mother's chest. This aligns the shoulders for easier delivery.
• Delivery of the anterior shoulder: The anterior shoulder is often delivered first by a combination of gentle downward traction and suprapubic pressure.
• Rotation of the shoulders: Once the anterior shoulder is delivered, gentle maneuvers are performed to rotate the posterior shoulder. This may involve using the fingers to sweep the posterior shoulder over the pubic symphysis.
• Delivery of the posterior shoulder: The posterior shoulder is then delivered with minimal traction.

4. Delivery of the Rest of the Body:

• Delivery of the trunk and lower extremities: After delivering the shoulders, the remaining parts of the baby’s body (trunk and lower extremities) are delivered smoothly using gentle traction.

5. Post-Maneuver Care:

• Assessment of the neonate: The baby's condition is carefully assessed immediately after delivery, including Apgar scores, and any necessary resuscitation measures are taken promptly.
• Assessment of the mother: The mother is also monitored for any signs of complications, such as vaginal or perineal lacerations.

Scientific Explanation and Underlying Principles

The MSV maneuver relies on several important anatomical and mechanical principles:

• Fetal head and shoulder anatomy: A thorough understanding of the fetal head and shoulder anatomy is crucial. The maneuver aims to align the fetal shoulders with the maternal pelvic dimensions.
• Biomechanics of delivery: The maneuver manipulates the forces involved in labor to overcome impediments in the birth canal. It utilizes leverage and controlled traction.
• Application of pressure: The combination of suprapubic pressure and downward traction helps to dislodge impacted shoulders.
• Leverage and rotational forces: The obstetrician uses gentle rotational forces to align the fetal shoulders with the birth canal, enabling easier delivery.

Potential Complications and Risks

While the MSV maneuver is a life-saving technique in difficult deliveries, it's important to acknowledge potential complications:

• Fractures of the clavicle or humerus: The baby's clavicle or humerus bones are at risk of fracture during the maneuver, particularly in shoulder dystocia.
• Brachial plexus injury: Damage to the brachial plexus nerves is a significant concern, potentially causing Erb's palsy or Klumpke's palsy.
• Perineal lacerations: The mother may experience vaginal or perineal tears.
• Fetal hypoxia: Prolonged use of the maneuver may lead to fetal hypoxia (lack of oxygen).
• Maternal hemorrhage: The maneuver can increase the risk of postpartum hemorrhage.

Minimizing these risks involves meticulous technique, proper assessment, and prompt intervention if complications arise. Experienced practitioners are essential to minimize these risks.

Frequently Asked Questions (FAQ)

Q: Is the Mauriceau-Smellie-Veit maneuver painful for the mother?

A: The procedure itself isn't inherently painful, but the underlying condition (shoulder dystocia, etc.) causing the need for the maneuver can be quite stressful for the mother. Pain medication may be given as needed.

Q: Is the Mauriceau-Smellie-Veit maneuver dangerous for the baby?

A: While the maneuver carries risks, it is generally safer than prolonged attempts at vaginal delivery when the baby is experiencing distress. Experienced providers can reduce these risks.

Q: How often is the Mauriceau-Smellie-Veit maneuver used?

A: The maneuver is used relatively infrequently. Its frequency depends on the incidence of conditions like shoulder dystocia, which varies geographically and across different populations.

Q: Are there any alternatives to the Mauriceau-Smellie-Veit maneuver?

A: Yes, several alternative techniques may be tried first, including McRoberts maneuver, suprapubic pressure, and Rubin's maneuver. Cesarean section is also an option if the MSV maneuver is not successful or not feasible.

Q: What should I expect if my baby needs the Mauriceau-Smellie-Veit maneuver?

A: If your healthcare provider determines the MSV maneuver is necessary, they will explain the procedure in detail. It’s important to trust your healthcare team's expertise in managing this situation.

Q: What are the long-term effects of the Mauriceau-Smellie-Veit maneuver on the baby?

A: Most babies who undergo the MSV maneuver experience no long-term effects. However, in some cases, there may be temporary or permanent nerve damage (brachial plexus injury) or bone fractures that require ongoing monitoring and treatment.

Conclusion

The Mauriceau-Smellie-Veit maneuver is a valuable obstetric technique used in specific high-risk deliveries. While it involves potential complications, its purpose is to facilitate a safe delivery when other methods are ineffective. Proper training, experience, and a thorough understanding of fetal anatomy and positioning are crucial for successful and safe execution of the maneuver. The decision to utilize the MSV maneuver is always made on a case-by-case basis by experienced healthcare professionals, considering the well-being of both the mother and the baby as the utmost priority. It is vital for expectant parents to understand that while rare, the MSV maneuver is a valuable tool in ensuring a healthy outcome in challenging deliveries. Open communication with healthcare providers is key to ensuring informed consent and managing expectations during labor and delivery.